MVP Advantage

PHCS / Multiplan Network

MVP Advantage is a limited benefit plan with no deductible that offers some of the most generous visit allowances in the MVP plan family, including 12 primary care visits, 12 specialist visits, and free telemedicine. It works best for generally healthy individuals who want predictable, low copays for routine doctor visits and want to avoid surprise costs at the point of care. Keep in mind this is not traditional major medical insurance and has annual limits on most services.

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Monthly premiums

member_only: $677.89/mo
child: $969.81/mo
spouse: $1,115.79/mo
family: $1,407.71/mo

The MVP Advantage plan operates on the PHCS/Multiplan network, one of the largest PPO networks in the country, meaning you can access in-network providers in all 50 states without a referral. The plan has no deductible, so you pay set copays from the very first visit — $15 for a primary care visit, $25 for a specialist, and $35 for urgent care. Telemedicine is included at no cost and is unlimited, making it easy to get care for everyday health concerns without leaving home. Preventive care is also covered at no cost when received outside of a hospital setting. For routine and ongoing care, MVP Advantage offers the most generous visit limits in the MVP plan family: up to 12 primary care visits and 12 specialist visits per plan year, plus 3 urgent care visits, up to 4 lab or radiology services (at a non-hospital location only), and up to 3 major imaging studies like CT or MRI scans per year (prior authorization required). If you need hospital care, inpatient stays are covered at a $350 copay per admission for up to 10 days, and emergency room visits carry a $350 copay for up to 2 visits per year. Up to 4 inpatient and 2 outpatient surgeries are also covered annually. Prescriptions are covered for preventive generics at $0 and non-preventive generics at $5; brand-name and specialty drugs are not covered. This plan is a good fit for self-employed individuals, part-time workers, or association members who are generally healthy, visit the doctor regularly, and want low, predictable out-of-pocket costs for routine care. It is particularly well-suited for those who can take advantage of the telemedicine benefit and want meaningful specialist access without needing a referral. However, there are important limitations to understand before enrolling. This is not traditional major medical or ACA-compliant insurance — it has annual caps on most services, and anything not listed in the plan's schedule of benefits is not covered. Out-of-network care is not covered at all. Lab work must be done outside of a hospital to be covered. Many services require prior authorization, and failing to get it can significantly reduce your benefits. Notable exclusions include durable medical equipment, rehabilitation therapies, dialysis, radiation and chemotherapy, hospice care, skilled nursing facilities, NICU, routine vision and dental, and maternity benefits carry a 12-month waiting period. This plan does not accept applicants based on health history (it is not guaranteed issue), so review the full schedule of benefits carefully to make sure the plan fits your anticipated healthcare needs.

Plan details

Deductible (Individual): $0
Deductible (Family): $0
Primary Care Copay: $15
Specialist Copay: $25
Urgent Care Copay: $35

Benefits

Deductible
$0 / $0
Copay
$15 / $25 / $35
PCP / Specialist / Urgent Care
Doctor Visits
12 PCP / 12 Specialist (separate) per year
Rx Coverage
$0 / $5
Preventive / Non-preventive · Brand/Specialty: Not Covered
Hospitalization
$350 copay/admission
10 days/yr
Surgeries
4 inpatient / 2 outpatient per yr
ER
$350 copay
2 visits/yr
Urgent Care
3 visits/yr
Lab Work
4 per year. NOT covered at a hospital.

MVP Advantage

Monthly premiums

Plan details

Benefits

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